A 73-year-old man was referred to our department because of recurrent epigastralgia and nausea. Esophagogastroduodeno- scopy revealed a pedunculated tumor in the greater curvature of the middle body and drawn folds from the gastric body into the pyloric side. After pushing the scope, the protruding tumor was shifted aside and a good view was obtained. Another pedunculated tumor was evident in the greater curvature of the gastric angle. Computed tomography and gastrography with a barium meal revealed a tumor prolapsing in the duodenum. A diagnosis of multiple early gastric cancer with ball valve syndrome was made. Endoscopic submucosal dissection was performed. Histopathological examination revealed a poorly differentiated adenocarcinoma with an invasion depth of submucosa and lymph vessel permeation was positive. Therefore, the patient underwent a total gastrectomy. He is being followed up regularly.
